Bill to block Medicaid expansion generates little interest in House

CONCORD - Former House Speaker William O'Brien said expanding Medicaid will wreck the state's budget, but he had little support at a public hearing Tuesday for his bill to permanently block expansion.

House Bill 271 would prohibit the state from expanding Medicaid - the federal-state health insurance program for the poor and disabled - under the Affordable Care Act. Under the expansion, those below 138 percent of the poverty level, or about $32,000 for a family of four or $15,400 for an individual, would be eligible.

O'Brien argued expanding the program would "hijack the state budget," addict the working poor to the program, and drive up the cost of private health insurance, but Mike Lessard of Dover told the House Health, Human Services and Elderly Affairs Committee, "We're talking about people, we're not talking about dollars and cents."

Lessard said he spoke for his brother, Jonathan, who works hard at his job but cannot afford health insurance and has not seen a doctor for years.

"What it basically comes down to is who do you work for?" he told the committee. "Who you fight for in this state is the people who can't fight for themselves."

Lessard was not alone. The bill was opposed by the vast majority of speakers, including representatives from the New Hampshire Hospital Association, insurance companies, health care providers, small businesses and social service advocates.

Assistant House Minority Leader John Hunt of Rindge said many programs were cut in the last budget cycle, including Children in Need of Services and aid to higher education.

"Now, we hear the constant calls to open up the checkbook to fund the various costs of implementing a brand new program," said Hunt. "We cannot and should not be forced to overlook programs like CHINS in favor of expansive new programs, that in the end, the federal government hasn't even committed to fully fund in the long term."

He said when the state is a little more flush financially, expansion could be revisited, but not now.

Expanding Medicaid is projected to add about 58,000 people to the program in seven years, and along with other provisions of the ACA, would reduce the state's uninsured from about 170,000 to 71,000, according to a study done for the state.

Expanding the program would cost the state about $85 million over seven years, but would inject $2.5 billion into the state's economy, according to the study.

As House Speaker, O'Brien fought expanding Medicaid saying the state could ill afford it. Tuesday he said the federal government has never lived up to its promises to states, using special education costs as an example, and will not now.

"New Hampshire will end up holding the financial bag," he said.

Tom Bunnell, policy specialist for New Hampshire Voices for Health, disputed O'Brien's financial claims, saying in the next biennium, expansion will infuse $422 million in federal funds into the state's economy without general fund cost to the state.

"We can cover more New Hampshire residents and save millions of dollars that is currently spent to treat uninsured people in emergency rooms," Bunnell said.

He said the state has the option of joining the federal expansion of Medicaid, and the option of opting out if the federal government does not live up to its promises of paying 100 percent of the cost over the first three years and then stepping down to 90 percent by the seventh year and beyond.

Pam Ean of Concord said medical care was affordable in the 1950s and early 1960s, but since then government involvement has driven up the cost tremendously.

When someone else is paying the bill, there is little incentive for a patient or a health care provider to keep costs lows, she said.

But Jane Lange of Nashua said many people like her need to know there is a safety net. She noted health coverage was not an issue for her until she was 63 years old and lost her job and her insurance.

Soon after she was diagnosed with cancer and needed an immediate operation. Her only option was to apply for Medicaid, which could take three to six months to be eligible, she said.

The committee will decide later what recommendation to make on the bill, which has little chance of passing in the Democratically-controlled House. Whether the state expands the program will more likely be decided during budget writing work. Gov. Maggie Hassan is to present her proposed budget to lawmakers Feb. 15.